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National EHR - Coggle Diagram
National EHR
Implementation
COTS Solution from Austria (strategic decision from MOH)
based on industry standards
compatible with the EHR profiles recommended by the EU commision
Future posibility of connecting with other EU countries - epsos
Proposed architecture: hybrid model
By 2015 the internet connectivity had improved
federated architecture combined with service oriented
Higher cost of implementation and maintanance as centralized architecture
Semantic standardization
Proposed: HL7 CDA L3
Promotes sharing information
Reuse of data
statistical analyses
Clinical research
The only classifier used was a version of ICD9
Challenges
create new localized classifier
nomenclatures
standardized clinical documents
The universal patient identification was missing
Hardware
Computerization of patient entry point and exit point
In these points employees can access the EHR system
Network infrastracture
Wireless access points
So the employees could use laptops or mobile devices
The national master patient index was implemented
Patient data privacy
Patient can decide to share or not the data with other HP
OPT-IN OPT-OUT
Patient must activate OPT-IN if he wish to participate
Architectural Models for HIE
Fully-federated (Decentralised)
Patient data is stored locally.
NO CDR
Pulls from the system of healthcare providers
Challenges
Maintain the connection
Monitor the connections and make sure they are online
Requires agreement from the provider to access the data
Federated (Decentralised)
Patient data is stored locally
Local CDRs
Pulls from a local CRD for updates to a central CDR
Dezentralized
Service-oriented
Send to a EHR system by a message
CDR holds care events within a patient record
Integrated Electronic Patient Record (Centralized)
Single integrated system
Data stored in a centralized repository
Hybrid
Combination/cross of centralized and dezentralized exchange
Study recommandations
The implementation of a nationwide EHR
Later the implementation of HIS
Suggestion: federated architecture
Enable operation of local facilities in offline mode
Shall include a fron-end solution for the providers
The need of ICT hardware to partially computerize public HPOs
Problems before national EHR implementation
underdeveloped ICT infrastracture
Small HP - no network infrastructure
Larger HP - only few computers for admission
Largest HP - computers in the admissions
Lack of national standards (terminology, protocols for data exchange)
Budget limitations
:red_cross:low computer literacy
Applications in use
Kosto spitali since 2011
Collect statistical , financial data
Standalone
Manually import export data
4 hospitals have started the deployment of HIS
Partially implemented - Application for gynecology in 2 maternities
No data exchange between the HPs
Results
national EHR deplyed in 79 public HPO in Albania
2300 ICT hardware items have been deployed
2740 end-users have been trained